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Summary

Aim:  to develop an effective and accessible “Peer Support” network for staff (local and potentially regional) after patient safety incidents and other traumatic events; with measurable impact.

Who does the project benefit? Primarily the health and wellbeing of healthcare staff. Secondary benefits will be to patients and families as improved staff wellbeing will potentially reduce sickness, improve morale and motivation.

Project type? Primarily development, provision and measurement of impact of learning to deliver peer support. This is part of a wider improvement project (without funding) to improve staff wellbeing following incidents.

Terms of funding: We are hoping to receive £29,790 to deliver this project in support of training, management and measurement. The team is in place to start delivery as soon as funds are received and are very passionate about sharing the work.

Background

The impact of traumatic events (e.g. patient safety incidents) upon healthcare professionals is well documented. However, very few organisations provide a systematic approach to care for individuals following unintentional events that harm patients (Denham, 2007).

The most precious resources in any healthcare organisation are the employees. Employees will make mistakes because they work in complex and often imperfect environments. The NHS has a legal, economical and moral obligation to support employees when things go wrong. Not only will this provide a better experience for staff (including improved health and wellbeing), it can help reduce the burden that is absenteeism and the subsequent operational and financial challenges that come with it.

Work to date

At Nottingham University Hospitals NHS Trust (NUH) we have developed a four-tier staff support structure based on Scott’s (2010) original model; we have named this “Supporting our Staff” (SoS); see the picture.

Tier 0:  Resources and support to develop emotional resilience.

Tier 1: Local/ colleague support in clinical areas. Online learning resources to develop supporters.

 Tier 2: Formalising a Peer Support network. Trained individuals who have the ability to talk with staff outside of their clinical environment to normalise incidents and signpost. Terms of Reference available as additional document.

Tier 3:  Formal/ expert support. Signposting to external networks and experts where required.

This work is fully supported by the organisation.

 

Idea

At NUH, ‘Supporting our Staff’ focusses on identifying the appropriate support for each individual. SoS aims to equip line managers and supervisors with the skills to deal immediately with their employees at times of crisis (tier 1) whilst also acknowledging that staff may wish to talk to someone else (tier 2).

NUH are developing a Peer Support (tier 2) network. To date SoS has trained 20 colleagues to hold conversations with employees who wish to speak with someone. They are not counsellors, but simply there to listen and assist the individual to move forward. Training has been limited because of funding and given the size of the organisation.

SoS wishes to further increase the network of peer supporters to be able to provide: one to one support and formalised debriefing after events.

What is required to support this idea?

  • Formalised training: scoped and identified to be best provided by TRiM: £24,990 (plus £800 for travel/ accommodation for facilitators)
  • Project analysis support (band 7, 4 hours per week for 6 months): £2500
  • Resource for marketing/ communications (£1000)/ Patient Involvement (£250)/ Staff travel for wider regional engagement (£250): £1500
  • Total: £29,790

Formalised training:

TRiM is provided by “March on Stress,” established in 2001. It has been well received in other NHS organisations and emergency services. The training covers trauma focussed peer support and debriefing with a qualification. By developing practitioners (n=48) and managers (n=8) to oversee the programme, TRiM can then be sustained at NUH.

  • 48 TRiM Practitioners: £18,990 (3 x 2 day workshops)

  • 8 TRiM Manager: £6000 (1 x 2 day workshop)

  • http://www.marchonstress.com/page/p/trim

This training will increase the number of Peer Supporters throughout the Trust. It means that NUH can provide support and debriefing across the Trust and potentially to other organisations across the region.

Measurement:

The impact of this training and support network will be an integral part of the aim. Measurement of impact will be achieved through:

  • Process: numbers accessing support and satisfaction with the process.
  • Outcome: safety climate and perception of support; friends and family test; wellbeing surveys; absenteeism; recruitment and retention.

Offers to the wider Q Community and healthcare:

Whilst training will be delivered at NUH, the offer to the wider Q Community is:

  • A patient and public representative to join training to provide insights.
  • A number of the places to be made available to Q Fellows outside of NUH to widen inclusion and provide skills to develop SoS in their own organisations.
  • Trained peer supporters to work inter-organisationally to create a network.

References

Scott SD, et al. (2010). Caring for our own: developing a systemwide second victim rapid response team. Jt Comm J Qual Pat Saf, 36(5), 233-240.

Denham CR. (2007). TRUST: the five rights of the second victim. J Pat Saf, 3(2), 107-19.

How you can contribute

  • Please support this work; staff are the greatest asset to the NHS and healthcare organisations must support their staff, particularly when things go wrong (and they will sometimes go wrong). Not only will this work impact staff, it potentially has the ability to impact quality through staffing, morale, safety culture and finances.
  • Access our tier 1 resources for more information at: https://www.youtube.com/playlist?list=PLZYtSvknSr0YD-_p-oRb3Nj-rR8eGKVk8
  • We can also provide more information around the wider resources; drop the SoS team an email at: NUHSoS@nuh.nhs.uk

Further information

Abridged ToRs for Peer Supporters (PDF, 248KB)

Comments

  1. Great to see all the interest in this idea. Could you say something more about the peer support aspect? Especially the mutual and reciprocal aspects at the heart of peer support, that would take it away from a peer- delivered intervention or assessment.

    1. Thank you Karen, most useful

      I have added an abridged version of our ToR for some info

      BW

      Nick

  2. Great idea, which I fully support. I am learning about second victim as part of my masters programme and have been interested to see the difference in responses to being involved in adverse incidents between professionals; for example nurses tend towards a more reflective process than some other professions, which does not always help them move on! Will you be considering the difference in approaches from staff groups/professions at all with the development and targeting of this project?

    1. Hi Clare, thank you

      Yes agree many different approaches needed for the various staff groups. The implementation group we are developing is MDT and has raised some of these issues for us to explore as we continue.

  3. Guest

    Janice Morgan 3 years, 6 months ago

    I fully support this idea. Thank you Nick, Charlotte, Karen and everyone else for bringing this project to life. I have been through times in my career where access to such support would have been so beneficial, and I know of colleagues who would think the same. Keep up the great work and I can’t wait to get updates on the project.

  4. Guest

    Karen Whiting 3 years, 6 months ago

    Thank you for all the supportive comments so far. I am incredibly proud to be leading on this at NUH. Our network of peer supporters will continue to grow with this to create a far greater MDT network.

    Happy to link with organisations to share our findings and learning so far.

  5. I fully support this project. At BCPFT, a mental health Trust, we have developed a team of staff debriefers who can meet with teams for group conversations further to incidents (both single severe ones, or times when there is a succession of smaller ones), at the request of the ward manager or matron. I addition we have developed ideas for staff t support each other in their teams. I am very interested in the individual 'peer' idea for staff who have been affected by e.g. suicide or aggressive incidents or who have to go through internal investigations or coroners proceedings. So this idea really appeals to me. I'm also impressed with the self-access resources for all staff

    I'd love to hear more about this project as it progresses.

    1. Thanks for the positive feedback. Debriefing formally of teams is an area we wish to pursue with training. How have you delivered training for this?

  6. Great idea. Incidents that happened years ago as a physio are still as clear as day to me, along with the guilt/shame/self-doubt/second-guessing that followed.

    Saw a project on Academy of Fabulous Stuff this week in Lancashire that may also be of interest to look at:

    http://fabnhsstuff.net/2018/05/09/new-traumatic-incident-service-staff/

     

    1. Thanks Jo, we will take a look!

  7. This sounds like a fabulous idea and I would love to understand more of what you are doing. We are looking at a similar issue for people who are involved in post incident reviews outside the organisation and how peer supporters could help with that.

  8. Guest

    Carrie Cramp 3 years, 7 months ago

    A vital scheme that will benefit staff across the board.

  9. Guest

    Laura Shepherd 3 years, 7 months ago

    As a Clinical Psychologist working at NUH, this is a project I would whole heartedly support. Looking after our staff is essential so that they can build resilience, work optimally and provide the best care to our patients.

  10. Guest

    Alison Dinning 3 years, 7 months ago

    I think this training is absolutely vital. Incidents and accidents will happen in a busy healthcare environment due to a variety of many well reported human factors. What is missing is supporting colleagues who are involved in these often distressing incidents. In the past few years this support may have been fragmented and patchy depending on the teams involved. To have a strong network of independent peers for the multi-professional team is crucial to staff well being. Excellent work.

  11. Guest

    Nick Woodier 3 years, 7 months ago

    Thank you all for the comments and support so far. There are also lots of comments and evidence of support on twitter: https://twitter.com/wooteachwoo/status/988444190098051073

    Dimple thank you for your message. All 20 are still in post and we are keen to get more! We have around 15000 staff in the organisation, so potentially a lot to do for only 20. We would also love to share wider with any write-ups/ publications. The hope with this is that we can offer some training spaces to the wider region to share.

    Karen thank you for the link to the IMH work, we will take a look.

    Keep the support coming!

  12. Hi team at NUH , thanks for sharing your idea!

     

    Supporting staff is vital and as we know, this has a direct impact on delivering excellent patient care.

     

    I wanted to check if supporting staff after an incident will also include administrative staff? They are often forgotten about when it comes to debriefing and offering support but ward clerks, receptionists, MDT coordinators etc are an intrinsic part of the patient journey and often (sadly) play a part in incidents.

     

    Out of curiosity I also wondered how many of the 20 trained staff members are still in post?

     

    In terms of measuring impact, I think you've got some good initial thoughts. I wanted to also highlight that Q offers the opportunity to write up QI reports as part of BMJ open quality and this could make an interesting write up

    (https://q.health.org.uk/get-involved/journals-and-learning-resources/)

    Thanks!

    Dimple

    Q Programme Manager

  13. Very pleased to see and this support this project, staff well being are hand-in-hand with patient safety, care can only be safer and better when both are addressed together.

  14. It's inevitable that things go wrong in hospitals, but the fewer lives damaged after mistakes the better for everyone. As a patient of NUH I fully support this bid. It will help the organization enhance learning-for-safety and boost its ethos of care for colleagues and therefore for patients. If succesful, it will be adoptable by other Trusts.

     

     

  15. Have a look at the work that the Institute of Mental Health (Nottingham) are doing with police forces around peer support. In particular, it would be worth you having a conversation about the learning from implementation and development of the project into Family Liaison Officer services. Marissa's contact details are on the IMH website - https://institutemh.org.uk/education/peer-and-welfare-support

  16. Guest

    Vicky Malia 3 years, 7 months ago

    Totally support this bid - and would really encourage a network that crosses professions.  Patient safety issues can impact on all sorts of staff and have a lasting effect if people are not supported properly through this.

  17. Guest

    Clare Walton 3 years, 7 months ago

    being involved in a safety incident can be very upsetting and challenging for any member of staff, to have a network of colleagues to provide timely support could make a huge difference. I fully support this bid.

  18. Guest

    Helen Mancini 3 years, 7 months ago

    Timely support after incidents is essential. Absolutely support this bid. Thank you for doing this.

  19. This sounds like such a valuable piece of work. Staff well being is vital, and this looks like a good model for providing the support that is required.

  20. Guest

    Rebecca Carlin 3 years, 7 months ago

    This will make a difference to colleagues and provide much needed support and is a really important piece of work.

  21. Guest

    This is a hugely important piece of work recognising the support needed for the people who deliver the care.

  22. Guest

    Nicola Fountain 3 years, 7 months ago

    I'm fully supportive of this project to support staff after a patient safety incident. A trained network of colleagues to provide timely support would be extremely beneficial to a wide range of healthcare staff.

  23. Guest

    Suzette Woodward 3 years, 7 months ago

    this is something I whole heartedly support - the links between staff wellbeing and the safety of patient care is well evidenced and strongly needed in today’s climate

  24. Guest

    Steph Knowles 3 years, 7 months ago

    I fully support this project as part of NUH's wider aim to improve the wellbeing of our staff. Developing a formal, evidenced based network of support will have a positive impact not just on the individuals who access the service but also in developing a wider NUH culture of fully supporting all staff which will ultimately improve the experience of us all and improve our patient care.

  25. Guest

    Owen Bennett 3 years, 7 months ago

    Supporting our staff after an incident is key to helping colleagues both normalise their responses to an event and to optimise their recovery. This project is crucial to caring for colleagues, valuing individuals and teams in order to make care safer both locally and nationally.

  26. The retention of staff within the NHS is vital in the delivery of safe, quality care. Supporting staff after an adverse incident at work is an essential tool which will help to ensure a healthy workforce is available to continue service delivery. The delivery of a robust, accessible team of trained peer supporters will be invaluable in ensuring all members of the workforce are supported and cared for, particularly if they have been involved in a difficult situation.

  27. Guest

    Charlotte Goedvolk 3 years, 7 months ago

    I fully support this project. Staff support after incidents is essential to retain workforce and to minimize negative psychological effects. A trained support network within the organization is essential. The formal QI approach ensures the benefits will be measured and allow us to share our learning with the Q-community.

    This work also links in with the learning from excellence and safety improvement work going on in the trust and has a great potential to further develop resilient health care.

  28. Guest

    Stephanie Smith 3 years, 7 months ago

    the option to have more timely support from recognised network of trained staff will be beneficial for many across our organisation and I support this bid.

  29. Guest

    In spite of my 30 years experience of work in the NHS, I am still susceptible to the emotional and psychological trauma which follows on significant clinical incidents. I have been fortunate to benefit from my own network of supportive colleagues but for many others this may not be something at their disposal at difficult times. A formalised network of supportive colleagues to facilitate reflection and a clearer (perhaps less negative) view of the roles we play in harmful events would be invaluable. I would support this initiative with my time and energy if I can be useful.

  30. Guest

    Nick Woodier 3 years, 7 months ago

    I am very proud to support this project and help lead on it; it has such potential to support staff, particularly at such a challenging time in healthcare. Unfortunately things do go wrong sometimes and we should be there for each other when they happen; this project will provide formal training to a wide network of staff to support others both at NUH and potentially wider.

     

    Please provide your support!

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